Tuesday, June 21, 2011

Placebos just as good as anti-depressants

From an article/book review by Marcia Angell in the current edition of the New York Review of Books:

"[Irving] Kirsch and his colleagues used the Freedom of Information Act to obtain FDA reviews of all placebo-controlled clinical trials, whether positive or negative, submitted for the initial approval of the six most widely used antidepressant drugs approved between 1987 and 1999—Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor. This was a better data set than the one used in his previous study, not only because it included negative studies but because the FDA sets uniform quality standards for the trials it reviews and not all of the published research in Kirsch’s earlier study had been submitted to the FDA as part of a drug approval application.

Altogether, there were forty-two trials of the six drugs. Most of them were negative. Overall, placebos were 82 percent as effective as the drugs, as measured by the Hamilton Depression Scale (HAM-D), a widely used score of symptoms of depression. The average difference between drug and placebo was only 1.8 points on the HAM-D, a difference that, while statistically significant, was clinically meaningless. The results were much the same for all six drugs: they were all equally unimpressive. Yet because the positive studies were extensively publicized, while the negative ones were hidden, the public and the medical profession came to believe that these drugs were highly effective antidepressants."

5 Comments:

"often overlooked amid all the controversy are the very real economic benefits that the world’s most advanced fast-rail system is bringing to China, and the competitive challenges it poses for the United States and Europe."

A ballot measure spearheaded by District 6's Jane Kim was "quietly" added to the November ballot yesterday, setting the stage for the first revision -- and arguable dismantling -- of Gavin Newsom's controversial Care Not Cash program.

Like all good liberals---except for people like me---the editors of the NY Times support high-speed rail, even though it's a dumb idea for the US. And it's not necessarily even a good idea for China, as the NY Times itself reported earlier this year. Whether China is a socialist or a capitalist system, it still has incurred a huge debt load with its HSR system. (If California is ever able to sell its HSR bonds authorized by the voters in 2008---which is unlikely---interest will be more than $600 million a year for state taxpayers.)

Interesting that the prog supervisors chose to put this measure on the ballot with no hearing and no debate. SF progs were rejected by city voters on the homeless issue twice: when Care Not Cash was passed in 2002, and again in 2003, when Gavin Newsom was elected mayor. Looks like they're going for strike three with this measure.

All the evidence shows that Care Not Cash has been more or less successful since it went into effect in 2004. Why do the progs think city voters will want to turn the clock back to pre-2002 days, when Food Not Bombs and the Biotic Baking Brigade dominated the debate in SF on homelessness?

Yes, Congressman Weiner's self-destruction was a great loss for New York's anti-bike movement.

"the medical profession came to believe that these drugs were highly effective antidepressants."

Did you read any of the studies?

Do any critical analysis?

Didn't think so.

1. For a variety of reasons SSRI medications rarely benefit patients with mild to moderate depression.

That's the first nit of USEFUL information you carefully omit to make your so-called "scandal" sound serious.

2. More than most, psychotropic medications are a matter "trial and error", "hit and miss", "let's try it and see if it helps". That's why psychiatrists use "flow sheets" to help decide what's the best first, second, third, N-th course of therapy.

Same applies to every other class of medications.

Less than 1/3 of medications of any class are effective for any particular diagnosis. That's one big reason genomic engineering holds such promise; finally, we'd have a means to match a general diagnosis with patient-specific effectiveness for particular medications.

You didn't mention any of that; it's even more difficult with anti-depressants, when treatment often requires multiple attempts to find a COMBINATION of medications that provides releif.

3. Trials like those cited often are unrealistic measures; they test a single variable, such as SSRI consumption, where real-world therapies often involve both medication and "talk therapy", each of which is continually adjusted to find effective treatment.

4. Diagnosable mental health disabilities afflict almost 40% of the american population at some point in our lives, and 20% in any given year, but we rarely diagnose or treat ourselves. It's even worse that the atrocious "system" we create to treat our physical ailments (many of which have mental health origins). Dismissing an often effective treatment for serious depression reduces ourselves, friends, families, co-workders, kids, and neighbors to needless, indescriable misery.

No, of course I haven't read the studies, and you should notice that I didn't write this post. Ms. Angell---and the authors of the books she's reviewing---has written about the FDA and the drug companies for years, and I posted this excerpt and a link to the NYR piece because she raises important issues.

It's ridiculous that we should have to use the Freedom of Information Act to get information on these studies from the FDA.

Whether this mental health epidemic even exists is one of the questions Angell raises.